Peter Aaby (middle) with two of the Bandim Health Project’s PhD researchers; Hanifi Manzoor (left) and Paul Welaga (right) who defended their doctoral theses at Staten’s Serum Institute in January 2018.

Anthropologist, Dr Peter Aaby is credited for the discovery of non-specific effects of vaccines.Since the 1980s, he and the Bandim Health Project in Guinea-Bissau have received a total of 50 million Kroner from the Ministry of Foreign Affairs of Denmark to development research with the last grant now dispersed by Danida Fellowship Centre.

By Vibeke Quaade

If there is a giant in the story of Denmark’s development research, it must be Peter Aaby. For almost 40 years, he has run the Bandim Health Project, a health and demographic surveillance system site that he established in Guinea-Bissau in 1978. He is credited for the discovery of non-specific effects of vaccines, leading the World Health Organization, WHO, to change its measles vaccine programme in the early 1990s.

He is also controversial, but that is to anticipate the story he tells me when he and I meet one late afternoon in January at Statens Serum Institut in Copenhagen.

The beginning
The story begins in 1978 when Peter Aaby was a young anthropologist doing research in Guinea-Bissau. The child mortality rate in Guinea-Bissau was extremely high. About half of the newborn babies died within the first five years of life.

At the time, it was widely believed that the high child mortality rate was due to malnutrition. Together with a team of three other researchers, Peter Aaby was assigned to investigate the correlation between malnutrition and child mortality and how the nutritional situation could be improved.

To our great surprise, we found very little severe malnutrition in Guinea-Bissau when the work started. However, while the research team was in Guinea-Bissau a severe measles epidemic broke out.

Watch the video interview with Peter Aaby here:

Theory of non-specific effects of vaccines
The team now discovered that instead of a correlation between malnutrition and child mortality, there was a connection between the children’s mortality risk and the intensity of their exposure to the illness.

This was about six or seven years before the global vaccination schemes sponsored by UNICEF came into place in the mid-eighties, so most of the children in Guinea-Bissau were not vaccinated against measles. Based on their new findings, the team carried out a general measles vaccination programme in their study area in Guinea-Bissau. This led the team to new research discoveries.

What happened was that once we started vaccinating against measles, the general child mortality dropped by 60 pct. It made us understand that not only did the new vaccination scheme prevent measles infection, but it also had other preventive effects, says Peter Aaby.

He speaks quickly, eager to explain the origin of his discovery of the non-specific effects of vaccines. In a few hours, he is off to Copenhagen Airport to catch the night flight to Guinea-Bissau. He has travelled this route hundreds of times since he first started to examine the measles vaccination’s unexpected side effects.

The Bandim Health Project helped to develop local, individual and institutional capacity through both training and partnerships. One success story is the establishment of the National Institute of Public Health. The Bandim Health Project also trained the project’s current Director of Research, Dr Amabelia Rodrigues. She was the first person in the country, and the first woman, to receive a PhD degree in health.

Breakthrough in WHO
Peter Aaby’s research was controversial then, and still is today.

The standard assumption at the time was a one-to-one link between vaccines and the disease that the particular vaccine would prevent. Our research questioned the one-to-one link because our data showed that the vaccine not only prevented measles, but also made other changes in the immune system, says Peter Aaby.

Further trials were conducted in several countries, all with the same result. There were unexplained side effects of measles vaccinations. Hardly anyone in the global health system took any notice. It did not discourage the Bandim team from pursuing their research and insisting that the existing vaccination system was based on a wrong assumption.

By the end of 1989, WHO introduced a new measles vaccine. Again, Peter Aaby and his team raised objections. Their studies showed that this particular vaccine was associated with a two-fold increase in mortality among girls.

We alerted WHO about our observations in 1990. In 1991, the experts dismissed them, but then, in 1992, US researchers working in Haiti confirmed that the girls who had received the new measles vaccine had indeed a higher mortality rate than the boys, he says.

The result was that WHO withdrew the vaccine. Had it not been withdrawn, it could have led to at least ½ million additional female deaths per year in Africa alone.

A man on a mission
Since then, Peter Aaby and the Bandim Health Project have documented non-specific effects in several trials of measles vaccine, BCG, oral polio vaccine, DTP vaccine and smallpox vaccine conducted in various countries in Africa and Asia and in Denmark.

Peter Aaby is controversial, but he is also highly respected. In 2009, he was named the fifth most influential person in Denmark in the fight against global poverty by Udvikling (Development), a magazine published by the Ministry of Foreign Affairs of Denmark.

Nonetheless, the Bandim Project’s findings have not brought about fundamental change in global disease prevention policy. The current policies do not take into account the fact that once you boost the immune system with a vaccine against one illness it may have other positive or negative side effects.

According to Peter Aaby, global policy continues to follow the thinking that he and his team already pointed out as being inadequate three decades ago. He sees this as a blind spot in the system, so he continues with his work.

You can say I am a man on a mission, he says.

He fears what may happen when global vaccination against eradicated diseases stops, as was the case when smallpox had been eradicated.

Polio may be eradicated already this year and measles within the next 10 years. If we stop vaccination, it may have very negative effects on morbidity in low-income countries

Research into the unknown
Our time is almost up. Peter Aaby has to go home and pack his bags and head off to the airport. Controversial or not, since the 1980s he and the Bandim project have received a total of 50 million Danish Kroner for development research from the Ministry of Foreign Affairs. I ask him if the Danish state’s investment has paid off.

I think it pays off to invest in development research as long as the supported research programmeisn’t designed to find what you think you should find, but rather to examine all the things you do not understand, he says and adds,

To examine the unknown is what research is all about.

Nine hundred scientific papers have been published and 63 researchers have received a doctoral degree or a PhD degree. Additionally, 13 Guineans have received a master’s degree from an overseas university as a result of the The Bandim Health Project, and some 45 Scandinavian PhD students have been associated with the Project to date. More than 150 local assistants, nurses, doctors and supervisors work for the Bandim Health Project, making it one of Guinea-Bissau’s biggest employers. The Bandim Health Project is associated with University of Southern Denmark and the Statens Serum Institut in Copenhagen where it has a small department.

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